OBGYN – Gyn Chart Review
[text name="name" default=""] [text name="age" default=""]YO G[text name="gest_prior" default=""]P[text name="preg_prior" default=""] with history significant for [text name="pmh" default=""] here for [text name="cc" default=""] HPI: [textarea name="hpi" fillable="" default=""] [checklist name="pmh_check" value="DVTs|smoking|thyroid|coagulopathy"] Symptoms to ask about: [textarea name="questions" fillable="" default=""] Gyn hx: [text name="lmp" fillable="" default="lmp"] every [text name="lmp_days" fillable="true" default="how many"] days [checklist name="aub_check" value="menopause?|abnormal uterine bleeding|intermenstrual bleeding"][textarea name="aub_hx" fillable="true" default="***age of menarche, lmp & days, period-associated symptoms***"] [checklist name="gyn_check" value="sexually active|using contraception"][textarea name="gyn_hx" fillable="true" default="***contraception type*** ***STIs: past dx, last screening*** ***prior gyn problems (inc breast)*** ***prior gyn surgeries***"] OB hx: [textarea name="ob_hx" fillable="true" default="***prior preg, weeks, vag or CS*** ***complications***"] Meds: [textarea name="meds" fillable="" default=""] Fam hx: [text name="famhx" fillable="" default=""] [checklist name="fam_cancers" value="breast|colon|endometrial|ovarian"] PE (what to focus): [textarea name="pes" fillable="" default=""] Labs: [textarea name="Labs" fillable="" default=""] [checklist name="gyn_check2" value="abnormal pap|pelvic US findings|mammogram"] Imaging: [textarea name="imaging" fillable="" default=""] Ddx: [textarea name="ddx" fillable="" default=""] Plan: [textarea name="plan" fillable="" default=""] Other: [textarea name="other_notes" fillable="" default=""]
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Sandbox Metrics: Structured Data Index 0.19, 26 form elements, 31 boilerplate words, 9 text boxes, 12 text areas, 5 check lists, 37 total clicks
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